PTSD and the Welfare System

Sufferers of Post-Traumatic Stress Disorder who apply for social security payments are frequently having their symptoms overlooked and their conditions ignored, forcing them to go through the long, draining process of appeal in order to get the payments they are entitled to.

Lucy Isaac, Casework Assistant

Post-Traumatic Stress Disorder (PTSD) is caused by a particularly traumatic event, such as abuse, war, torture or the death of a loved one. The symptoms of PTSD are complex. These include, but are not limited to: flashbacks, intrusive thoughts and images, nightmares, pain, sweating, nausea, insomnia, self-harm and suicidal ideation.[1]

At Z2K, we receive a high number of referrals from charities such as Freedom from Torture and the Helen Bamber Foundation whose clients are often sufferers. We represent these clients in their appeals for Employment and Support Allowance (ESA), after the Department for Work and Pensions (DWP) has determined that they are fit for work.

One such client is Alana*, a survivor of torture. When she was 21, she was detained by the Ethiopian authorities. For three years, she was subject to interrogation, torture and some of the most heinous sexual abuse I have heard of.

To talk to, Alana is calm and collected. She is kind and intelligent, she smiled and laughed. You cannot see that she suffers from chronic depression, anxiety and Post-Traumatic Stress Disorder. It is only when you listen to her that you begin to realise the severity of her conditions and their debilitating effects on her life. When you hear what she has been through and the suffering she continues to endure, it is clear that work or work-related activities are an impossibility.

Yet, at her assessment for ESA, she was awarded 0 points and deemed fit to work.

For the second time, Alana had to go through appeal, a process which forced her to revisit the darkest times in her life by relaying them to strangers such as myself and the panel. The effect of this was that her depression and anxiety intensified and she had to even pick up an extra hour a week of counselling to deal with it.

The appeal was successful without the need to give oral evidence, as the judge could tell from her medical reports alone that she was not well enough to work. Yet none of this was recognised at assessment.

Alana is not alone in her experiences. The symptoms of PTSD, much like many other mental health conditions, are on the most part, internalised. Sufferers laugh and smile and shake your hand, but inside can be feeling panic, fear and anxiety. There is not one single test to diagnose the condition, and even to a trained eye it can be difficult to spot.[2]

Yet for welfare benefits, DWP relies on non-specialist healthcare professionals to make assessments based mainly on a person’s visual appearance.

Below are just some examples of the characteristics the healthcare professional used to determine that Alana was fit for work:

  • “looks well”
  • “did not appear to be trembling”
  • “increased sweating was not apparent”
  • “did not make rocking movements”
  • “normal facial expression”
  • “normal manner”
  • “behaved normally”

The questions asked by healthcare professionals in order to assess mental health issues are not realistic, and are unlikely to be present in a sufferer of PTSD. There might be good days and bad days, hidden symptoms and effects which go beyond the tick-box style questions.

If more time was spent looking at Alana’s medical documents and giving her the chance to explain how her conditions affect her, she could have been spared the stress and re-traumatisation around the appeal process, which did nothing but hinder her recovery.




*Names have been changed to protect privacy




Keep up to date with our work by joining our communications – click here


  • April 15, 2021 · Blog | Campaigning | Housing & homelessness | Private Rented Sector project | Rose Bernstein

    Renters Need Change Now

    Housing law allows landlords to evict tenants without giving a reason - meaning people like Okwuchi often face prejudice or are punished for asking for repairs. It's this...

  • April 7, 2021 · Covid-19 | Lucy Isaac | Tribunals project

    Retrospective on Remote Social Security Hearings

    Prior to the national lockdown, Z2K’s Tribunal representation project largely revolved around client contact. From our initial meeting with clients at outreach sessions and appointments at our offices...

  • March 18, 2021 · Covid-19 | Latest News | Legacy benefits | Marc Francis

    Legacy Benefits – a year of denial

    A year ago, I was one of millions watching the Chancellor’s press conference outlining an emergency package for businesses and individuals affected by the lockdown. When he...